Information Technology in Surgery The Cutting Edge Chapter 7

Computer-Assisted Surgery Surgical planning:  Virtual reality  Virtual environments help teach and plan surgeries Minimally invasive surgery (MIS)

Computer-Assisted Surgery Minerva  Stereotactic neurosurgery HERMES  FDA-cleared system software that connects operating room hardware into a voice-controlled network

Minimally Invasive Surgery (MIS) Endoscope projects an image of the surgical site onto a monitor. MIS is performed through small incisions, resulting in less pain and shorter recovery time.

Figure 7.1 A demonstration of minimally invasive surgery. Source: Norman Chan/Shutterstock.com

MIS Surgeon sees image on a monitor; MIS is image-directed. Minimally invasive heart surgery is now (2011) in clinical trials at 40 sites in the U.S. Endoluminal surgery is done through natural orifices.

Minimally Invasive Surgery (MIS) Minimally-invasive heart surgery  In minimally invasive heart surgery for valve replacement, a catheter is inserted into the femoral artery.  Then a device called a CoreValve – made of a special alloy and heart material from a pig – is threaded through the blood vessels to the aortic valve using X-ray guidance.

Minimally Invasive Surgery (MIS) Minimally-invasive heart surgery  Once implanted, it expands and becomes an entirely new gateway.  In Europe, the CoreValve has been approved; 15,000 people have had the surgery.

Figure 7.2 Instruments of minimally invasive surgery. Source: iStockphoto.com/Michael Miller

Robots Used to hold endoscopes Able to decide if tissue is normal ROBODOC  Hip replacements AESOP  First FDA-cleared surgical robot, holds endoscope

Robots ZEUS  Minimally invasive microsurgery da Vinci  Minimally invasive heart repair, including mitral valve repairs

Robots da Vinci  In 2009 in the U.S., 86% of prostate surgeries were performed using da Vinci.  According to a study of Medicare patients, it did lead to fewer complications in the hospital, but had worse results for impotence and incontinence.

Robots da Vinci  In October 2010, da Vinci performed the first all-robotic surgery in Canada.

Figure 7.3 Images showing hands on the master controls of the surgeon console and the operative screen. Source: Courtesy of Intuitive Surgical (©2011 Intuitive Surgical, Inc.).

Figure 7.4 Images showing two surgeon consoles, a patient cart, and a vision cart. Source: Courtesy of Intuitive Surgical (©2011 Intuitive Surgical, Inc.).

Figure 7.5 Dr. Renata Bastos Ford (left), Dr. W. Randolph Chitwood (center), and Dr. Chayanin Vatcharasiritham in the operating room. Source: Courtesy of the East Carolina Heart Institute at East Carolina University.

Figure 7.6 Dr. W. Randolph Chitwood (not pictured) performing a robotic mitral valve repair in the operating room. Source: Courtesy of the East Carolina Heart Institute at East Carolina University.

da Vinci Mitral Valve Surgery Video View video on “da Vinci Mitral Valve Surgery” located in Chapter Review Section

Robots NeuroArm Robot  Developed at the University of Calgary in Canada  Unlike other surgical robots, it can operate in an MRI.  Its arms can be moved 50 microns at a time—a microscopic scale. These tiny, steady movements make it safer to operate on the human brain.

Robots SpineAssist  A robot that can be clamped on a patient's back  Doctors take a picture of where the spine surgery will take place and a computer plans the robot's path

Robots SpineAssist  The robot creates a three-dimensional map of a patient's spine  Following the path, SpineAssist actually drills into the patient's vertebrae.  Has successfully completed 2000 surgeries

Augmented Reality Makes use of computer-generated imagery to provide the surgeon with information that otherwise would be unavailable. The computer-generated images may either be fused with the image on the monitor or projected directly onto the patient's body during the operation, allowing the doctor to virtually see inside the patient.

CAVEman Four-dimensional computer image, which includes length, width, height, and time 3,000 body parts Images can be displayed on body Can help plan surgeries and educate patients

Telepresence Surgery Distance surgery  Gall bladder (2001)  Prostate cancer (2002)  Correction of acid reflux (2003)

NEEMO NASA Extreme Environment Mission Operation NEEMO is a series of NASA missions in which groups of scientists live in Aquarius

NEEMO Aquarius is the only undersea lab in the world. It is 13 feet wide and 45 feet long with approximately 400 square feet of space for living and laboratory activities. NEEMO 7 and 9 included doctors, but no surgeons.

NEEMO The major purpose of these projects is to enable astronauts to be operated on in space from earth using wireless technology and robotics. One of NEEMO 7's goals was to see whether doctors with no training in surgical techniques could successfully perform surgery with the help of telementoring and telerobotics.

NEEMO 9, 12, and 14 NEEMO 9 succeeded in assembling a surgical robot, and completed surgeries controlled by a doctor in Canada. NEEMO 12's crew conducted advanced medical experiments using robotic telesurgery.

NEEMO 9, 12, and 14 NEEMO 14 (completed in May 2011), did not include surgeries, but did simulate the transfer of an incapacitated astronaut from the ocean floor to the deck of the craft, a maneuver that might need to accompany surgery in the future.

NEEMO 12: Training Training for NEEMO 12  An astronaut or aquanaut uses a still camera to photograph plants in the undersea habitat for the 12th NEEMO mission.

NEEMO: Raven A two-armed remotely controlled surgical robot from the University of Washington known as Raven is photographed inside the undersea habitat for the 12th NEEMO mission.

Figure 7.7 A two-armed remotely controlled robot named RAVEN set up in the operating room of NEEMO 12. Source: Courtesy of NASA.

The Operating Room of the Future In the operating room of the future, images from all sources will be available to surgeons and other personnel. The display on four screens (called the wall of knowledge) shows integrated patient information in an easy-to- understand format, in one location.

The Operating Room of the Future Information displayed includes a patient's vital statistics, allergies, and the whereabouts of OR personnel. Personnel, including doctors, are identified and tracked by RFID tags. The OR of the future makes three- dimensional real-time images available in surgery, linking PACS with the operating room.

Lasers in Surgery Light amplification by the stimulated emission of radiation Can cut, vaporize tumors, seal small blood vessels Beam can be narrowed to the size of a few cells

Uses of Lasers in Surgery Used in:  Gynecology  Orthopedics  Urology  ENT  Cardiovascular  Gastroenterology  Dermatology  Ophthalmology

Figure 7.8 Lasers in surgery can cut, vaporize tumors, and seal small blood vessels. Source: Larry Mulvehill/Corbis

Uses of Lasers in Surgery Used to:  Prevent blood loss  Slow the spread of tumors  Reduce pain  Remove some brain and liver tumors  Eliminate clots causing strokes  Dissolve plaque in arteries  Treat and cure early-stage mouth and throat cancer, leaving the voice intact

LASIK Uses lasers to correct vision by changing the shape of the cornea.

Figure 7.9 A doctor performing laser eye surgery. Source: Monkey Business Images/Shutterstock.com

Nanotechnology Works with objects on the scale of atoms and molecules.  A nanometer is one-billionth of a meter (1/75,000 of a human hair). The world's lightest carbon material (multiwalled carbon nanotube (MCNT) aerogel) has been created.  Could be used to improve robotic surgery

Nanotechnology In the future, nanotechnology may help in cancer surgeries.  Nanoparticles that can bind to cancer cells are injected into the body. Special scanning equipment can be used to identify every cell involved in the cancer, which can then be removed.

Nanotechnology Research is also being done on the use of nanomaterials in orthopedic surgery both in:  Enhancing the cell response selectively for biological tissue integration  Increasing the strength and wear resistance of current orthopedic materials

Nanotechnology Researchers in Germany have found that certain types of lasers are capable of reaching pulse energies that will allow modifications of living cells, e.g., making accurately controlled incisions in cell structures. A laser could be used as a scalpel to operate on one cell.

Conclusion The use of augmented images to teach surgeons and plan and guide operations can reduce unnecessary cutting and make operations more precise and less invasive. MIS is less invasive and minimizes hospital stays and recovery time.